posted
Cobra has run out and it's time to get on insurance plan from spouses employer.
There's the Q&A part where they ask if you've been diagnosed with any of the following diseases and you check them off. Of course, they threaten to drop you if you leave anything out or if they find information later on that conflicts with what you provided on the application.
A doctor incorrectly diagnosed me with Fibromyalgia a couple of years ago, when in actuality it was EBV.
I want to answer no because I didn't have FM but if they search doctor records they might find that this doctor diagnosed me with it albeit incorrectly.
There's nothing to check off for Lyme, but there's a section where you specify "other." Do I put down chronic Lyme?
The ISDA says chronic Lyme doesn't exist and insurance companies don't want to pay for the tx, so I feel justified in not putting it down. I have not had abx tx for Lyme, but I've been to an LLMD for consultations.
My stance is that the insurance companies can't have it both ways. If they don't pay for chronic Lyme tx because they agree with the ISDA's stance that it doesn't exist, then I shouldn't have to put it down on the app. Why should I claim I have something that they say doesn't exist?
Then on the other hand, I don't want to get dropped and accused of fraud.
Insurance companies are truly evil.
-------------------- -chaps �Listen to the bell, Borrelia. It tolls for thee!� Posts: 631 | From A little place called, "we'll see." | Registered: Apr 2010
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- If fibromyalgia is in your medical chart, you could stick with that for consistency. Or you could explain that is was a misdiagnosis and state EBV.
I the EBV test is in your file and that is positive, you have that as proof. But EBV can red-flag your file if it is chronic (if they believe in chronic). But, really, everyone has been exposed to EBV and most are thought to get over it - so it may not red-flag your chart unless it was an IgM test that shows persistent infection - or if titers were high for current infection within the past 6 months.
Were your lyme tests CDC positive? If not, do not add lyme to the "other" section. According to the CDC, you would not have lyme. Period.
No, do not volunteer "chronic lyme" as the CDC and IDSA say there is no such thing. So, if you list "chronic lyme" you could be [falsely] labeled a hypochondriac and that will set off some bad vibes.
If you submit claims for payment for treatment, that could pose a few problems if the doctor uses the ICD-9 code for lyme. There are other ways to code things, of course, and there may be other reasons for the treatment choices that will be used.
Did you test positive for other tick-borne or other chronic stealth infections? Babesia? etc.
Be sure however you answer that your doctor is on the same page. As you mention, honestly is important to ensure coverage. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- I thought that it is now illegal for health insurance to deny policies due to pre-existing conditions? You may want to call your state's insurance commissioner office and ask that question. No details, just ask that question.
[edited to add: see reply below by bcb1200] -
[ 11-23-2010, 01:35 PM: Message edited by: Keebler ]
Posts: 48021 | From Tree House | Registered: Jul 2007
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posted
well we are going through the same thing.......We are coming to the end of my cobra this year and wanted to see if transferring us to a BCBS plan now would cut the cost.
Was told by an insurance agent I would definatley not get coverage.....great !!...so that made me mad......same as you if they dont recognize it as a condition how can they deny you coverage because of it.......
so i thought well well see how much for my husaband and 2 girls.....on the medical questionnaire it actually asks you have you been diagnosed with chronic lyme????.........WOW again dont recognize it but have it on the application........so at that point I knew I definatley wouldnt get it.....
anyway we went on for my family to find out my husband was aslo denied coverage because he had a spot of melanoma removed last year !!!!!....he is fit as anything, works hard, doesnt smoke or drink, takes no meds and yet denied because of that,..!!!!!
So now at 38 and 41 we are both uninsurable........wonderful.............
also the insurance agent said there is no point lying because they can trawl a database that holds everyones medical information......I thought No they cant do that....surely.....well when they called me about my daughter..they had information of what DR she had seen in 2008 and the fact that she had had an MRI at then at 1 yr old........nothing wrong but that had to go back to underwriting for a decision.........
so the moral of the story is they know everything.......and if an individual plan they will deny you on anything........
dont think they can deny you on a group plan for pre existing......though.............
sorry for the long response but so mad about the whole situation..............
-------------------- Oct 09 Positive CDC Western Blot Jan 10 Positive Babesia Duncani Jan 10 Cd57 28 Mar 10 EBV, IgM, IgG HHV-6 IgG Posts: 739 | From NC | Registered: Oct 2009
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Oh, they may (or may not) be able deny coverage for pre-existing condition but they could deny if there is any whisper of "fraud" by not listing all conditions. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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bcb1200
Frequent Contributor (1K+ posts)
Member # 25745
posted
quote:Originally posted by Keebler: - I thought that it is now illegal for health insurance to deny policies due to pre-existing conditions? You may want to call your state's insurance commissioner office and ask that question. No details, just ask that question. -
Not true. THat starts in 2012. But...many company provided plans do not have exclusions for pre-existing conditions as long as there is no lapse in the insurance going from one policy to another.
-------------------- Bite date ? 2/10 symptoms began 5/10 dx'd, after 3 months numerous test and doctors
IgM Igenex +/CDC + + 23/25, 30, 31, 34, 41, 83/93
Currently on:
Currently at around 95% +/- most days. Posts: 3139 | From Massachusetts | Registered: May 2010
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Keebler
Honored Contributor (25K+ posts)
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posted
- bcb1200,
thanks for the detail. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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posted
I don't think I'll be denied coverage because there's no lapse and this is my spouse's employer-provided plan.
My main concerned is not getting dropped down the road.
On my previous Lyme Labcorp tests, ELISA tests showed negative. All Western Blots showed only one band positive (41) and 39 indeterminant, overall negative result.
On the IGENEX test, IGG 41 was positive, 39 indeterminant, IGM 41 indeterminant. So this was a negative dx on the WB.
The PCR plasmid test showed positive, but it also states on the results page that this test is not approved by the FDA. This is the part that gets sticky.
Don't want to get accused of fraud and get dropped. Don't want to open a can of worms with inconclusive unapproved results, either.
-------------------- -chaps �Listen to the bell, Borrelia. It tolls for thee!� Posts: 631 | From A little place called, "we'll see." | Registered: Apr 2010
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Yes, that database is managed by the Medical Information Bureau. It is basically an information clearinghouse more or less run by the insurance companies.
I was denied an individual policy when my COBRA expired due to previously diagnosed and treated health conditions.
It is amazing to me that not only the insurance companies can do us in, but incompetent doctors making incorrect assessments can also trip us up in this process.
Posts: 56 | From Down Here | Registered: May 2010
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posted
I know all the misdiagnosis in the past for me primarily hospitalized and treated twice in 2009 for "migriane"..........which i have never had...but now is on my record saying so...........again great !!!
-------------------- Oct 09 Positive CDC Western Blot Jan 10 Positive Babesia Duncani Jan 10 Cd57 28 Mar 10 EBV, IgM, IgG HHV-6 IgG Posts: 739 | From NC | Registered: Oct 2009
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posted
i had no health insurance the last 3 years. didnt want it. i recently applied for health insurance because i found out i had lyme disease thru igenex test so i applied with bcbs so that i could afford treatment.
i also had a tough time filling stuff out. there was one question that said if you have had any condition in the last 10 years? I told the lady helping me with the app that i've had undiagnosed pain the last 8 years so what am i supposed to put? she said put no if it was never diagnosed.
i figure it says right on igenex tests that they do not count as a diagnosis. my IgG was CDC positive but I don't think they reported me. If I was reported, do they give the name of the patient too?
That's the only way I would be in trouble. Anyway they flagged me....but guess what for.
ACNE. they wanted to know if acne was still a problem. then they finally approved me and said i'm in a one year probationary period where they won't treat anything pre-existing.
they won't treat any pre-existing illness that was diagnosed? or they just won't treat any pre-existing illness at all? how can they prove anything?
momlyme
Frequent Contributor (1K+ posts)
Member # 27775
posted
Sad. How much are you paying for the insurance? Deductibles? Is it an 80/20 split?
Most LLMDs don't take insurance anyway. I wonder if it's not a waste of money?
Definitely not advice, hope my ramblings help.
-------------------- May health be with you!
Toxic mold was suppressing our immune systems, causing extreme pain, brain fog and magnifying symptoms. Four days after moving out, the healing began. Posts: 2007 | From NY/VT Border | Registered: Aug 2010
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posted
i pay $239/ mo. not sure if its worth it or not since half the stuff i buy isn't at the doc office and llmd's dont accept insurance. but i'm just starting out so id rather be "safe" than sorry. who knows, maybe its not safe at all.
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Definitely not advice, hope my ramblings help.
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